MEDICARE: FC TN, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1457936858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FC TN, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 5802
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5802
Country	:	US
Telephone Number	:	156-003-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 TROUSDALE DR STE 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-4538
Country	:	US
Telephone Number	:	615-913-8550
Fax Number	:	615-933-3977

Authorized Official
Title or Position	:	CFO
Name	:	ANDREW M DEANE
Credential	:
Telephone Number	:	615-600-3480

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	05/13/2021

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